World Asthma Day  

Dr Udaya Sureshkumar

An event celebrated on the first Tuesday of the month of May, which commemorates a day to create awareness about asthma. This year the theme is "Access to anti-inflammatory inhalers for everyone with asthma – still an urgent need.”

Asthma - being a disease existing from long ago - is still attached with a lot of stigma. We still see parents being very hush-hush about the term “asthma”, refusing to disclose it openly, and adding on to it influencing the same stigma in children's minds. Asthma like cancer is labelled not completely cured or lifelong but so is diabetes and hypertension, to name just a couple. 

The presentation in childhood is what alarms everyone. So let us try to understand the disease and the meaning of the theme. Essentially, asthma is a disease of the airways, which means the tubes carrying the air we breathe to the spongy areas of the lungs for exchange of gases. These tubes are sensitive to a variety of stimuli like dust, viral infections, pollen, allergens, strong odours, cold temperature, etc., as these are also one of the first lines of defense in our body. Anything considered as foreign or allergic for that particular individual - depending on prior exposure - is thrown out by the body via choking of the tubes and producing cough, this choking leads to wheezing and breathlessness. 

To relieve the choking our body produces mucous, which can be thought of like a lubricant, to soothe and get the airways back to normal. In people with allergies and triggers this becomes a recurrent process depending on the exposure leading to recurrent symptoms. Naturally, if this choking is not relieved it can lead to reduced oxygen supply to the body causing acute asthma attack presentation which can be life-threatening. The ability of the lungs to come back to normal in a short period is also due to certain natural body enzymes present in our blood which work on the muscles. This is the hallmark of asthma known as reversible disease, which is why some patients feel better post steam at home or other local remedies which in essence contain some bronchodilator content of nature. When such episodes become very frequent the smooth muscles in the tubes become overworked and hypertrophied and fail to relax, leading to a state of constant choking and wheezing. 

Patients tend to show a seasonal variation with more symptoms in pre-monsoon and winter, due to the environmental increase in pollen and other triggers. The other characteristic feature is predominant night and early morning symptoms, leading to hospital emergency visits. This is attributed to the normal circadian rhythm which has fluctuations in normal cortisol and other hormones which have a bronchodilatory effect. 

We also have other types of asthma which can be non-allergic, due to a rise in early onset obesity seen in children, whereas it is later onset in adults. This is explained by the increase in adipose and smooth muscle ratio in airways and leading to reduced reversibility.

So the treatment has changed, and the reason why the new guidelines are stressing on “anti-inflammatory inhalers”. Till recent times, short acting bronchodilators(SABA) were the mainstay of treatment, used for daily and as-and-when symptoms relief. But now, studies have confirmed that excessive use of SABA leads to long term worsening and low compliance with controller medicines (inhalers with small dose of inhaled steroids and longer acting bronchodilators). The inhaled steroid component acts as an anti-inflammatory agent and reduces the hypertrophy of the smooth muscles. The longer acting (12 hours) bronchodilators give longer symptomatic relief and better control. So holistically using a controller antiinflammatory daily provides a better future to the patient with less remodeling of the airways and prevents long-term worsening. This does not mean that one is addicted to the inhaler as a lot of patients quote. Inhaled medicines only act on the lung and are minimally absorbed in the blood to cause any kind of addiction. It's mere concept of “Prevention is better than Cure.” 

So let's bash the myth and pledge to use our anti-inflammatory controller inhalers and stay healthy and lead a normal life. 

(Dr Udaya Sureshkumar is a Consultant Pulmonologist with KMC Hospital)